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Question 1.1. A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary
care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient
reports lightheadedness associated with standing up. The NP should consult with the patient’s
cardiologist about changing the medication to: (Points : 2)
amlodipine (Norvasc).
isradipine (DynaCirc).
verapamil HCl (Calan).
short-acting nifedipine (Procardia).
b. verapamil HCl (Calan).
Verapamil and diltiazem are less likely to cause hypotension than nifedipine and related drugs, such
as isradipine and amlodipine.
Question 2.2. A patient who will begin using nitroglycerin for angina asks the primary care NP how the
medication works to relieve pain. The NP should tell the patient that nitroglycerin acts to: (Points : 2)
dissolve atheromatous lesions.
relax vascular smooth muscle.
prevent catecholamine release.
reduce C-reactive protein levels.
relax vascular smooth muscle.
Nitrates relax vascular smooth muscle via stimulation of intracellular cyclic guanosine
monophosphate production with the major effect being to reduce myocardial oxygen demand.
Nitrates do not dissolve atheromatous lesions, prevent catecholamine release, or reduce C-reactive
protein levels.
Question 3.3. A patient with Graves’ disease is taking methimazole. After 6 months of therapy, the
primary care NP notes normal T3 and T4 and elevated TSH. The NP should: (Points : 2)
order a complete blood count (CBC) with differential.
order aspartate aminotransferase, AGT, and LDH tests.
decrease the dose of the medication.
add levothyroxine to the patient’s regimen.
c. decrease the dose of methimazole
Question 4.4. The primary care nurse practitioner (NP) sees a patient in the clinic who has a blood
pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL;
triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a body mass index
of 29. The patient has a positive family history for cardiovascular disease. The NP should: (Points : 2)
prescribe a thiazide diuretic.
consider treatment with an angiotensin-converting enzyme inhibitor.
reassure the patient that these findings are normal.
counsel the patient about dietary and lifestyle changes.
d. counsel the patient about dietary and lifestyle changes.
The patient’s blood pressure indicates prehypertension, but the patient does not have cardiovascular
risk factors such as hyperlipidemia or hyperinsulinemia. The body mass index indicates that the
patient is overweight but not obese. Pharmacologic treatment is not recommended for
prehypertension unless compelling reasons are present. The findings are not normal, so it is
appropriate to counsel the patient about diet and exercise.
Question 5.5. A 45-year-old patient who has a positive family history but no personal history of
coronary artery disease is seen by the primary care NP for a physical examination. The patient has a
body mass index of 27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density
lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides, 120 mg/dL. The patient
does not smoke but has a sedentary lifestyle. The NP should recommend: (Points : 2)
30 minutes of aerobic exercise daily.
taking 81 to 325 mg of aspirin daily.
beginning therapy with a statin medication.
starting a thiazide diuretic to treat hypertension.
30 minutes of aerobic exercise daily.
This patient is overweight but not obese, and blood lipids are within normal limits. Blood pressure is
not elevated. Exercise is recommended as an initial risk reduction strategy because of its positive
effects on blood pressure and blood lipids. Aspirin is generally given to patients older than 55 to 65
who are at risk. Statin medications and thiazide diuretics are not indicated.
Question 6.6. A patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s
body mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol
tests are normal. The primary care NP should order: (Points : 2)
a b-blocker.
an angiotensin-converting enzyme inhibitor.
a thiazide diuretic.
dietary and lifestyle changes.
C. a thiazide diuretic.
The patient has stage I hypertension. Because there are no compelling indications for other treatment,
a thiazide diuretic should be used initially to treat the hypertension. Dietary and lifestyle changes
should also be recommended but are not sufficient for patients with stage I hypertension. Other drugs
may be added later if thiazide diuretic therapy fails
Question 7.7. An 80-year-old male patient will begin taking an a-antiadrenergic medication. The
primary care NP should teach this patient to: (Points : 2)
ask for assistance while bathing.
restrict fluids to aid with diuresis.
take the medication in the morning with food.
be aware that priapism is a common side effect.
a.
ask for assistance while bathing.
All antihypertensives can cause orthostatic hypotension, so patients should be cautioned to avoid
sudden changes in position and to use caution when bathing because a hot bath or shower may
aggravate dizziness. Older patients are at increased risk for falls and should be cautioned to ask for
assistance. Patients taking a-antiadrenergics should consume extra fluids because dehydration can
increase the risk of orthostatic hypotension. Patients should take the medication at bedtime because
drowsiness is a common side effect. Priapism is not a side effect of these drugs.
Question 8.8. A patient who is taking nifedipine develops mild edema of both feet. The primary care
NP should contact the patient’s cardiologist to discuss: (Points : 2)
changing to amlodipine.
ordering renal function tests.
increasing the dose of nifedipine.
evaluation of left ventricular function.
d. changing to amlodipine.
Mild to moderate peripheral edema occurs in the lower extremities in about 10% of patients; this is
caused by arterial dilation, not by left ventricular dysfunction. Amlodipine is less likely to have this
effect. Renal function tests are not indicated. Increasing the nifedipine dose would worsen the
symptoms.
Question 9.9. A primary care NP sees a 46-year-old male patient and orders a fasting lipoprotein profile
that reveals LDL of 190 mg/dL, HDL of 40 mg/dL, and triglycerides of 200 mg/dL. The patient has no
previous history of coronary heart disease, but the patient’s father developed coronary heart disease at
age 55 years. The NP should prescribe: (Points : 2)
atorvastatin (Lipitor).
gemfibrozil (Lopid).
cholestyramine (Questran).
lovastatin/niacin (Advicor).
d. atorvastatin (Lipitor).
HMG-CoA reductase inhibitors are used to treat hyperlipidemia when the LDL is the primary lipid
elevation. This patient has risk factors of being a man older than 45 years, with a positive family
history of coronary heart disease before age 55 in a male first-degree relative. Gemfibrozil is used for
patients with elevated triglycerides and low HDL. Bile acid sequestrants are used as adjunctive and
not first-line therapy for reducing LDL. A combination product is not indicated for first-line therapy.
Question 10.10. A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice
daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and
hemoglobin A1c is 7.3%. The NP should: (Points : 2)
begin insulin therapy.
change to therapy with colesevelam (Welchol).
add a third oral antidiabetic agent to this patient’s drug regimen.
enroll the patient in a weight loss program to achieve better glycemic control.
a. begin insulin therapy
Question 11.11. A patient who is newly diagnosed with type 2 diabetes mellitus has not responded to
changes in diet or exercise. The patient is mildly obese and has a fasting blood glucose of 130 mg/dL.
The patient has normal renal function tests. The primary care NP plans to prescribe a combination
product. Which of the following is indicated for this patient? (Points : 2)
Metformin/glyburide (Glucovance)
Insulin and metformin (Glucophage)
Saxagliptin/metformin (Kombiglyze)
Metformin/pioglitazone (ACTOplus met)
a. Metformin/glyburide (Glucovance)
Question 12.12. A patient who has type 2 diabetes mellitus takes metformin (Glucophage). The patient
tells the primary care NP that he will have surgery in a few weeks. The NP should recommend: (Points :
2)
taking the metformin dose as usual the morning of surgery.
using insulin during the perioperative and postoperative periods.
that the patient stop taking metformin several days before surgery.
adding a sulfonylurea medication until recovery from surgery is complete.
b.
using insulin during the perioperative and postoperative periods.
Response Feedback:
Insulin should be considered for patients with diabetes during times of physical stress, such as illness
or surgery.
Question 13.13. The primary care NP sees a new African-American patient who has blood pressure
readings of 140/90 mm Hg, 130/85 mm Hg, and 142/80 mm Hg on three separate occasions. The NP
learns that the patient has a family history of hypertension. The NP should: (Points : 2)
initiate monotherapy with a thiazide diuretic.
prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
discuss dietary and lifestyle modifications with the patient.
begin combination therapy with an ARB and a calcium-channel blocker.
a.
initiate monotherapy with a thiazide diuretic.
African Americans tend to respond better than whites to diuretic monotherapy, so this is an
appropriate starting therapy. Calcium-channel blockers and ARBs are preferred as adjunct
medications in African Americans.
Question 14.14. A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child
weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult
with a pediatric endocrinologist to discuss: (Points : 2)
increasing the dose to 90 mcg/day.
decreasing the dose to 30 mcg/day.
stopping the medication and checking TSH and T4 in 4 weeks.
discussing the need for lifetime replacement therapy with the child’s parents.
c.
Stopping the medication and checking TSH and T4 in 4 weeks
Question 15.15. A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping
blood glucose within normal limits and has had multiple episodes of both hypoglycemia and
hyperglycemia. As adjunct therapy to manage this problem, the primary care NP should prescribe:
(Points : 2)
pramlintide (Symlin).
repaglinide (Prandin).
glyburide (Micronase).
metformin (Glucophage).
a.
pramlintide (symlin)
Response Feedback:
Pramlintide is indicated in patients with type 1 diabetes and insulin-dependent type 2 diabetes and is
helpful for patients with wide glycemic swings. Repaglinide requires a functioning pancreas to be
effective. Glyburide and metformin are first-line oral agents and are not indicated.
Question 16.16. A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release,
for a patient with chronic stable angina. The NP should teach the patient to: (Points : 2)
change the patch four times daily.
use the patch as needed for angina pain.
use two patches daily and change them every 12 hours.
apply one patch daily in the morning and remove in 12 hours.
d.
apply one patch daily in the morning and remove in 12 hours.
To avoid tolerance, the patient should remove the patch after 12 hours. The transdermal patch is not
changed four times daily or used on a prn basis. The patch is applied once daily.
Question 17.17. A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic
and begins having chest pain. The primary care NP administers a nitroglycerin tablet and instructs the
patient to lie down. The NP’s next action should be to: (Points : 2)
obtain an electrocardiogram.
administer oxygen at 2 L/minute.
give 325 mg of chewable aspirin.
call EMS.
b.
administer oxygen at 2 L/minute.
When a patient experiences an acute attack of angina in the clinic, the primary care NP should be
prepared to treat the condition. After giving nitroglycerin, oxygen should be administered. An
electrocardiogram is not immediately indicated. Chewable aspirin is given if the angina is unrelieved
and when the patient is being transported to the hospital. EMS should be activated if there is no pain
relief 5 minutes after the first dose of nitroglycerin.
Question 18.18. A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary care
NP should order: (Points : 2)
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage).
c. Glucophage
Question 19.19. A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency.
When teaching this patient about the medication, the NP should: (Points : 2)
counsel the patient to take the medication with food.
tell the patient that changing brands of the medication should be avoided.
instruct the patient to stop taking the medication if signs of thyrotoxicosis occur.
tell the patient that the drug may be stopped when thyroid function tests stabilize.
b. tell the patient that changing brands of the medication should be avoided.
Patients should be told not to change brands of the medication; there ispotential variability in the
bioequivalence between manufacturers. Themedication should be taken at approximately the same
time each day beforebreakfast or on an empty stomach. Patients should be instructed to contactthe
provider if signs of thyrotoxicosis are present. Thyroid replacementmedications are usually given for
life
Question 20.20. A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2
weeks. The patient reports continued fatigue. The primary care NP should: (Points : 2)
order a T4 level today.
increase the dose to 100 mcg.
check the TSH level in 1 week.
reassure the patient that this will improve in several weeks.
c. Check the TSH level in 1 week
Question 21.21. A patient who has stable angina is taking nitroglycerin and a b-blocker. The patient
tells the primary care NP that the cardiologist is considering adding a calcium channel blocker. The NP
should anticipate that the cardiologist will prescribe: (Points : 2)
isradipine (DynaCirc).
nicardipine (Cardene).
verapamil HCl (Calan).
nifedipine (Procardia XL).
d.
verapamil HCl (Calan).
Nitrates and b-blockers are first-line therapy for stable angina. Calcium channel blockers should be
reserved for patients who cannot take these agents or patients whose symptoms are not controlled
with these agents. Verapamil is one of the calcium channel blockers that should be used. The other
calcium channel blockers are not recommended for this purpose
Question 22.22. A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an annual physical
examination, the patient’s fasting plasma glucose is 130 mg/dL. The patient walks 1 mile three or four
times weekly. She has had two children who weighed 7 lb and 8 lb at birth. Her personal and family
histories are noncontributory. The primary care NP should: (Points : 2)
order metformin (Glucophage).
order a lipid profile, complete blood count, and liver function tests (LFTs).
order an oral glucose tolerance test.
set a weight loss goal of 10 to 15 lb.
d. Set a weight loss goal of 10-15 lbs
Response Feedback:
To prevent or delay onset of diabetes, patients with impaired glucose should be advised to lose 5% to
10% of body weight. Metformin should be considered in patients with high risk of developing
diabetes. This woman does not have risk factors. Other tests are not indicated.
Question 23.23. The primary care NP is preparing to prescribe isosorbide dinitrate sustained release
(Dilatrate SR) for a patient who has chronic, stable angina. The NP should recommend initial dosing of:
(Points : 2)
60 mg four times daily at 6-hour intervals.
40 mg twice daily 30 minutes before meals.
60 mg on awakening and 40 mg 7 hours later.
80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM.
b.
40 mg twice daily 30 minutes before meals.
Long-acting nitrates should be considered to treat chronic, stable angina. The main limitation is
tolerance, which can be limited by providing a nitrate-free period of 6 to 10 hours each day. The
medication should be taken on an empty stomach, 30 to 60 minutes before a meal. An appropriate
initial dose of isosorbide dinitrate is 40 mg every 12 hours. This dose can be increased as needed.
Isosorbide mononitrate is given on awakening and again 7 hours later. The medication is not given
four times daily. Dosing may be increased to 80 mg tid, and the dosing schedule of 8:00 AM, 1:00
PM, and 6:00 PM. would be appropriate at that point.
Question 24.24. A patient who has type 2 diabetes mellitus will begin taking a bile acid sequestrant.
Which bile acid sequestrant should the primary care NP order? (Points : 2)
Colesevelam (Welchol)
Colestipol (Colestid)
Cholestyramine (Questran)
Cholestyramine (Questran Light)
a.
Colesevelam (Welchol)
Response Feedback:
All bile acid sequestrants are equally effective. Colesevelam has an additional indication to improve
glycemic control in adults with type 2 diabetes and so should be selected when prescribing a bile acid
sequestrant for this patient
Question 25.25. A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The
primary care NP should contact the patient’s cardiologist to discuss adding: (Points : 2)
amlodipine (Norvasc).
diltiazem (Cardizem).
verapamil HCl (Calan).
nifedipine (Procardia XL).
c.
nifedipine (Procardia XL).
Nifedipine and related drugs are potent vasodilators, which makes them more effective for
hypertension than verapamil and diltiazem. Amlodipine is not a first-line drug.
Answers:
These are the automatically computed
results of your exam. Grades for essay
questions, and comments from your
Date Taken:
instructor, are in the “Details” section Time Spent:
below.
Points Received:
Question Type:
# Of Questions:
Multiple Choice
25
2/28/2016
40 min , 22 secs
48 / 50 (96%)
# Correct:
24
Grade Details – All Questions
A patient who has angina is taking nitroglycerin and long-acting
nifedipine. The primary care NP notes a persistent blood pressure of
90/60 mm Hg at several follow-up visits. The patient reports
lightheadedness associated with standing up. The NP should consult
Question 1. Question :
with the patient’s cardiologist about changing the medication to:
Student Answer:
amlodipine (Norvasc).
isradipine (DynaCirc).
verapamil HCl (Calan).
short-acting nifedipine (Procardia).
Instructor
Verapamil and diltiazem are less likely to cause hypotension than nifedipine
Explanation:
and related drugs, such as isradipine and amlodipine.
Points Received:
2 of 2
Comments:
Question 2. Question :
Student
Answer:
A patient who will begin using nitroglycerin for angina asks the
primary care NP how the medication works to relieve pain. The NP
should tell the patient that nitroglycerin acts to:
dissolve atheromatous lesions.
relax vascular smooth muscle.
prevent catecholamine release.
reduce C-reactive protein levels.
Nitrates relax vascular smooth muscle via stimulation of intracellular cyclic
guanosine monophosphate production with the major effect being to reduce
Instructor
myocardial oxygen demand. Nitrates do not dissolve atheromatous lesions, prevent
Explanation: catecholamine release, or reduce C-reactive protein levels.
Points Received:
2 of 2
Comments:
Question 3. Question :
Student
Answer:
A patient with Graves’ disease is taking methimazole. After 6 months
of therapy, the primary care NP notes normal T3 and T4 and elevated
TSH. The NP should:
order a complete blood count (CBC) with differential.
order aspartate aminotransferase, AGT, and LDH tests.
decrease the dose of the medication.
add levothyroxine to the patient’s regimen.
Once clinical levels of thyrotoxicosis have been resolved, elevated TSH indicates
a need to reduce the dosage. A CBC with differential is performed at the
beginning of treatment and when signs of infection are present. Liver function
Instructor
tests may be monitored periodically but are not indicated by the current laboratory
Explanation: results. Levothyroxine is not indicated.
Points Received:
2 of 2
Comments:
The primary care nurse practitioner (NP) sees a patient in the clinic
who has a blood pressure of 130/85 mm Hg. The patient’s laboratory
tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120
mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a
body mass index of 29. The patient has a positive family history for
Question 4. Question :
cardiovascular disease. The NP should:
Student Answer:
prescribe a thiazide diuretic.
consider treatment with an angiotensin-converting enzyme inhibitor.
reassure the patient that these findings are normal.
counsel the patient about dietary and lifestyle changes.
Instructor
The patient’s blood pressure indicates prehypertension, but the patient does not
Explanation:
have cardiovascular risk factors such as hyperlipidemia or hyperinsulinemia. The
body mass index indicates that the patient is overweight but not obese.
Pharmacologic treatment is not recommended for prehypertension unless
compelling reasons are present. The findings are not normal, so it is appropriate
to counsel the patient about diet and exercise.
Points Received:
2 of 2
Comments:
Question 5. Question :
Student
Answer:
A 45-year-old patient who has a positive family history but no
personal history of coronary artery disease is seen by the primary care
NP for a physical examination. The patient has a body mass index of
27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal
low-density lipoprotein, 110 mg/dL; high-density lipoprotein, 70
mg/dL; and triglycerides, 120 mg/dL. The patient does not smoke but
has a sedentary lifestyle. The NP should recommend:
30 minutes of aerobic exercise daily.
taking 81 to 325 mg of aspirin daily.
beginning therapy with a statin medication.
starting a thiazide diuretic to treat hypertension.
This patient is overweight but not obese, and blood lipids are within normal limits.
Blood pressure is not elevated. Exercise is recommended as an initial risk
reduction strategy because of its positive effects on blood pressure and blood
Instructor
lipids. Aspirin is generally given to patients older than 55 to 65 who are at risk.
Explanation: Statin medications and thiazide diuretics are not indicated.
Points Received:
2 of 2
Comments:
Question 6. Question :
Student
Answer:
A patient has three consecutive blood pressure readings of 140/95 mm
Hg. The patient’s body mass index is 24. A fasting plasma glucose is
100 mg/dL. Creatinine clearance and cholesterol tests are normal. The
primary care NP should order:
a b-blocker.
an angiotensin-converting enzyme inhibitor.
a thiazide diuretic.
dietary and lifestyle changes.
The patient has stage I hypertension. Because there are no compelling indications
for other treatment, a thiazide diuretic should be used initially to treat the
hypertension. Dietary and lifestyle changes should also be recommended but are
Instructor
not sufficient for patients with stage I hypertension. Other drugs may be added
Explanation: later if thiazide diuretic therapy fails.
Points Received:
2 of 2
Comments:
Question 7. Question :
Student
Answer:
An 80-year-old male patient will begin taking an a-antiadrenergic
medication. The primary care NP should teach this patient to:
ask for assistance while bathing.
restrict fluids to aid with diuresis.
take the medication in the morning with food.
be aware that priapism is a common side effect.
All antihypertensives can cause orthostatic hypotension, so patients should be
cautioned to avoid sudden changes in position and to use caution when bathing
because a hot bath or shower may aggravate dizziness. Older patients are at
increased risk for falls and should be cautioned to ask for assistance. Patients
taking a-antiadrenergics should consume extra fluids because dehydration can
increase the risk of orthostatic hypotension. Patients should take the medication at
Instructor
bedtime because drowsiness is a common side effect. Priapism is not a side effect
Explanation: of these drugs.
Points Received:
2 of 2
Comments:
Question 8. Question :
Student
Answer:
A patient who is taking nifedipine develops mild edema of both feet.
The primary care NP should contact the patient’s cardiologist to
discuss:
changing to amlodipine.
ordering renal function tests.
increasing the dose of nifedipine.
evaluation of left ventricular function.
Mild to moderate peripheral edema occurs in the lower extremities in about 10% of
patients; this is caused by arterial dilation, not by left ventricular dysfunction.
Instructor
Amlodipine is less likely to have this effect. Renal function tests are not indicated.
Explanation: Increasing the nifedipine dose would worsen the symptoms.
Points Received:
2 of 2
Comments:
Question 9. Question :
Student
Answer:
A primary care NP sees a 46-year-old male patient and orders a fasting
lipoprotein profile that reveals LDL of 190 mg/dL, HDL of 40 mg/dL,
and triglycerides of 200 mg/dL. The patient has no previous history of
coronary heart disease, but the patient’s father developed coronary
heart disease at age 55 years. The NP should prescribe:
atorvastatin (Lipitor).
gemfibrozil (Lopid).
cholestyramine (Questran).
lovastatin/niacin (Advicor).
HMG-CoA reductase inhibitors are used to treat hyperlipidemia when the LDL is
Instructor
the primary lipid elevation. This patient has risk factors of being a man older than 45
Explanation: years, with a positive family history of coronary heart disease before age 55 in a
male first-degree relative. Gemfibrozil is used for patients with elevated
triglycerides and low HDL. Bile acid sequestrants are used as adjunctive and not
first-line therapy for reducing LDL. A combination product is not indicated for firstline therapy.
Points Received:
2 of 2
Comments:
A patient with type 2 diabetes mellitus takes metformin (Glucophage)
1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an
annual physical examination, the BMI is 29 and hemoglobin A1c is
Question 10. Question :
7.3%. The NP should:
Student Answer:
begin insulin therapy.
change to therapy with colesevelam (Welchol).
add a third oral antidiabetic agent to this patient’s drug regimen.
enroll the patient in a weight loss program to achieve better glycemic
control.
The target hemoglobin A1c goal for adults is less than 7%. Insulin therapy is
indicated if maximum doses of two oral antidiabetic drugs are not effective.
This patient is taking the maximum recommended doses of metformin and
glyburide. Colesevelam does not decrease hemoglobin A1c. Adding a third oral
Instructor
antidiabetic agent is not recommended. A weight loss program may be a part of
Explanation:
this patient’s treatment, but insulin is necessary to maintain glycemic control.
Points Received:
2 of 2
Comments:
A patient who is newly diagnosed with type 2 diabetes mellitus has not
responded to changes in diet or exercise. The patient is mildly obese
and has a fasting blood glucose of 130 mg/dL. The patient has normal
renal function tests. The primary care NP plans to prescribe a
combination product. Which of the following is indicated for this
Question 11. Question :
patient?
Student Answer:
Metformin/glyburide (Glucovance)
Insulin and metformin (Glucophage)
Saxagliptin/metformin (Kombiglyze)
Metformin/pioglitazone (ACTOplus met)
Obese patients with normal renal function and elevated fasting plasma glucose
Instructor
may be started on a combination of metformin and a second-generation
Explanation:
sulfonylurea.
Points Received:
2 of 2
Comments:
Question 12. Question :
A patient who has type 2 diabetes mellitus takes metformin
(Glucophage). The patient tells the primary care NP that he will have
surgery in a few weeks. The NP should recommend:
Student Answer:
Instructor
Explanation:
Points Received:
Comments:
taking the metformin dose as usual the morning of surgery.
using insulin during the perioperative and postoperative periods.
that the patient stop taking metformin several days before surgery.
adding a sulfonylurea medication until recovery from surgery is
complete.
Insulin should be considered for patients with diabetes during times of
physical stress, such as illness or surgery.
0 of 2
The primary care NP sees a new African-American patient who has
blood pressure readings of 140/90 mm Hg, 130/85 mm Hg, and 142/80
mm Hg on three separate occasions. The NP learns that the patient has
Question 13. Question :
a family history of hypertension. The NP should:
Student Answer:
initiate monotherapy with a thiazide diuretic.
prescribe a thiazide diuretic and an angiotensin-converting enzyme
inhibitor.
discuss dietary and lifestyle modifications with the patient.
begin combination therapy with an ARB and a calcium-channel
blocker.
African Americans tend to respond better than whites to diuretic
monotherapy, so this is an appropriate starting therapy. Calcium-channel
Instructor
blockers and ARBs are preferred as adjunct medications in African
Explanation:
Americans.
Points Received:
2 of 2
Comments:
A child who has congenital hypothyroidism takes levothyroxine 75
mcg/day. The child weighs 15 kg. The primary care NP sees the child
for a 3-year-old check-up. The NP should consult with a pediatric
Question 14. Question :
endocrinologist to discuss:
Student Answer:
increasing the dose to 90 mcg/day.
decreasing the dose to 30 mcg/day.
stopping the medication and checking TSH and T4 in 4 weeks.
discussing the need for lifetime replacement therapy with the child’s
parents.
In congenital hypothyroidism, therapy may be stopped for 2 to 8 weeks after
Instructor
the patient reaches 3 years of age. If TSH levels remain normal, thyroid
Explanation:
supplementation may be discontinued permanently.
Points Received:
2 of 2
Comments:
Question 15. Question :
A patient who has insulin-dependent type 2 diabetes reports having
difficulty keeping blood glucose within normal limits and has had
multiple episodes of both hypoglycemia and hyperglycemia. As
adjunct therapy to manage this problem, the primary care NP should
prescribe:
Student
Answer:
pramlintide (Symlin).
repaglinide (Prandin).
glyburide (Micronase).
metformin (Glucophage).
Pramlintide is indicated in patients with type 1 diabetes and insulin-dependent type
2 diabetes and is helpful for patients with wide glycemic swings. Repaglinide
Instructor
requires a functioning pancreas to be effective. Glyburide and metformin are firstExplanation: line oral agents and are not indicated.
Points Received:
2 of 2
Comments:
A primary care NP prescribes a nitroglycerin transdermal patch, 0.4
mg/hour release, for a patient with chronic stable angina. The NP
Question 16. Question :
should teach the patient to:
Student Answer:
change the patch four times daily.
use the patch as needed for angina pain.
use two patches daily and change them every 12 hours.
apply one patch daily in the morning and remove in 12 hours.
To avoid tolerance, the patient should remove the patch after 12 hours. The
Instructor
transdermal patch is not changed four times daily or used on a prn basis. The
Explanation:
patch is applied once daily.
Points Received:
2 of 2
Comments:
Question 17. Question :
Student
Answer:
A patient who has stable angina and uses sublingual nitroglycerin
tablets is in the clinic and begins having chest pain. The primary care
NP administers a nitroglycerin tablet and instructs the patient to lie
down. The NP’s next action should be to:
obtain an electrocardiogram.
administer oxygen at 2 L/minute.
give 325 mg of chewable aspirin.
call EMS.
When a patient experiences an acute attack of angina in the clinic, the primary care
NP should be prepared to treat the condition. After giving nitroglycerin, oxygen
should be administered. An electrocardiogram is not immediately indicated.
Chewable aspirin is given if the angina is unrelieved and when the patient is being
Instructor
transported to the hospital. EMS should be activated if there is no pain relief 5
Explanation: minutes after the first dose of nitroglycerin.
Points Received:
2 of 2
Comments:
Question 18. Question :
Student Answer:
Instructor
Explanation:
Points Received:
Comments:
A 12-year-old patient who is obese develops type 2 diabetes mellitus.
The primary care NP should order:
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage).
Metformin is the only drug listed that is recommended for children.
2 of 2
A primary care NP prescribes levothyroxine for a patient to treat
thyroid deficiency. When teaching this patient about the medication,
Question 19. Question :
the NP should:
Student Answer:
counsel the patient to take the medication with food.
tell the patient that changing brands of the medication should be
avoided.
instruct the patient to stop taking the medication if signs of
thyrotoxicosis occur.
tell the patient that the drug may be stopped when thyroid function
tests stabilize.
Patients should be told not to change brands of the medication; there is potential
variability in the bioequivalence between manufacturers. The medication
should be taken at approximately the same time each day before breakfast or on
an empty stomach. Patients should be instructed to contact the provider if signs
Instructor
of thyrotoxicosis are present. Thyroid replacement medications are usually
Explanation:
given for life.
Points Received:
2 of 2
Comments:
A patient who has hypothyroidism has been taking levothyroxine 50
mcg daily for 2 weeks. The patient reports continued fatigue. The
Question 20. Question :
primary care NP should:
Student Answer:
order a T4 level today.
increase the dose to 100 mcg.
check the TSH level in 1 week.
reassure the patient that this will improve in several weeks.
Full therapeutic effectiveness may not be achieved for 3 to 6 weeks. Measuring
Instructor
the TSH level is indicated to evaluate drug effectiveness. The dose should not
Explanation:
be increased without first evaluating the patient’s TSH level.
Points Received:
2 of 2
Comments:
Question 21. Question :
A patient who has stable angina is taking nitroglycerin and a b-
blocker. The patient tells the primary care NP that the cardiologist is
considering adding a calcium channel blocker. The NP should
anticipate that the cardiologist will prescribe:
Student
Answer:
isradipine (DynaCirc).
nicardipine (Cardene).
verapamil HCl (Calan).
nifedipine (Procardia XL).
Nitrates and b-blockers are first-line therapy for stable angina. Calcium channel
blockers should be reserved for patients who cannot take these agents or patients
whose symptoms are not controlled with these agents. Verapamil is one of the
Instructor
calcium channel blockers that should be used. The other calcium channel blockers
Explanation: are not recommended for this purpose.
Points Received:
2 of 2
Comments:
A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an
annual physical examination, the patient’s fasting plasma glucose is
130 mg/dL. The patient walks 1 mile three or four times weekly. She
has had two children who weighed 7 lb and 8 lb at birth. Her personal
Question 22. Question :
and family histories are noncontributory. The primary care NP should:
Student Answer:
order metformin (Glucophage).
order a lipid profile, complete blood count, and liver function tests
(LFTs).
order an oral glucose tolerance test.
set a weight loss goal of 10 to 15 lb.
To prevent or delay onset of diabetes, patients with impaired glucose should be
advised to lose 5% to 10% of body weight. Metformin should be considered in
Instructor
patients with high risk of developing diabetes. This woman does not have risk
Explanation:
factors. Other tests are not indicated.
Points Received:
2 of 2
Comments:
The primary care NP is preparing to prescribe isosorbide dinitrate
sustained release (Dilatrate SR) for a patient who has chronic, stable
Question 23. Question :
angina. The NP should recommend initial dosing of:
Student Answer:
60 mg four times daily at 6-hour intervals.
40 mg twice daily 30 minutes before meals.
60 mg on awakening and 40 mg 7 hours later.
80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM.
Long-acting nitrates should be considered to treat chronic, stable angina. The
main limitation is tolerance, which can be limited by providing a nitrate-free
period of 6 to 10 hours each day. The medication should be taken on an empty
stomach, 30 to 60 minutes before a meal. An appropriate initial dose of isosorbide
Instructor
dinitrate is 40 mg every 12 hours. This dose can be increased as needed.
Explanation:
Isosorbide mononitrate is given on awakening and again 7 hours later. The
medication is not given four times daily. Dosing may be increased to 80 mg tid,
and the dosing schedule of 8:00 AM, 1:00 PM, and 6:00 PM. would be
appropriate at that point.
Points Received:
2 of 2
Comments:
Question 24. Question :
Student
Answer:
A patient who has type 2 diabetes mellitus will begin taking a bile acid
sequestrant. Which bile acid sequestrant should the primary care NP
order?
Colesevelam (Welchol)
Colestipol (Colestid)
Cholestyramine (Questran)
Cholestyramine (Questran Light)
All bile acid sequestrants are equally effective. Colesevelam has an additional
Instructor
indication to improve glycemic control in adults with type 2 diabetes and so
Explanation: should be selected when prescribing a bile acid sequestrant for this patient.
Points Received:
2 of 2
Comments:
Question 25. Question :
Student
Answer:
A patient who takes nitroglycerin for stable angina pectoris develops
hypertension. The primary care NP should contact the patient’s
cardiologist to discuss adding:
amlodipine (Norvasc).
diltiazem (Cardizem).
verapamil HCl (Calan).
nifedipine (Procardia XL).
Nifedipine and related drugs are potent vasodilators, which makes them more
Instructor
effective for hypertension than verapamil and diltiazem. Amlodipine is not a firstExplanation: line drug.
Points Received:
2 of 2
Comments:
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